Provider Demographics
NPI:1386667392
Name:GARRETT, NATASHA I (DO)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:I
Last Name:GARRETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W LANCASTER AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1743
Mailing Address - Country:US
Mailing Address - Phone:610-644-8069
Mailing Address - Fax:610-644-6736
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1743
Practice Address - Country:US
Practice Address - Phone:610-644-8069
Practice Address - Fax:610-644-6736
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA084531HUZMedicare ID - Type Unspecified
PAI19398Medicare UPIN